In this third issue of Clinical issues in HIV, we present another two case studies, which highlight some of the challenges of diagnosing and managing patients with HIV.
HIV-infected patients are at increased risk of developing acute kidney injury (AKI), a complication associated with excess in-hospital mortality. Incidence has fallen in the era of widespread antiretroviral therapy (ART), presumably as a consequence of a reduction in severe opportunistic infections, but it still remains above that of non-infected individuals. Risk factors are increasingly those affecting the general population, reflecting the proportion of HIV-positive patients in long-term stable care, and include: pre-existing diabetes, hypertension, chronic kidney disease (CKD) and use of angiotensin-converting enzyme inhibitors or angiotensin receptor blockers; these all serve to lower the threshold for AKI during intercurrent illness.
Mr X is a 24-year-old Polish man who first presented to our genitourinary medicine (GUM) service in December 2015 for post-exposure prophylaxis (PEP). He presented having had condomless receptive anal sex the previous night with an HIV-positive casual male partner he had met via Grindr (a geospatial networking app). He was unaware of his partner’s HIV viral load. He had been smoking ‘Tina’ (crystal methamphetamine) and snorting ‘Meph’ (mephedrone), drugs commonly associated with ‘chemsex’ (sexualised use of recreational drugs). He gave a history of 25 casual male sexual partners in the last three months. He almost never uses condoms and usually is the receptive partner for anal intercourse. He had used PEP once before, the previous year, but had diarrhoea throughout treatment. When he attended the GUM service in December 2015, a sexual health screen revealed Neisseria gonorrhoeae infection of the throat and rectum, which was treated appropriately. He was also given a hepatitis B vaccination booster.